A Cross-sectional Study of Antiglaucoma Drug Utilisation and Prescribing Patterns in a Tertiary Care Hospital, Udaipur, Rajasthan, India

1. PhD Research Scholar, Department of Pharmacology, Pacific Medical University, Udaipur, Rajasthan, India. 2. Professor, Department of Pharmacology, Pacific Medical University, Udaipur, Rajasthan, India. 3. Professor, Department of Ophthalmology, American International Institute of Medical Sciences, Udaipur, Rajasthan, India.

Abstract

Introduction: Glaucoma is one of the leading causes of irreversible blindness worldwide and requires long-term pharmacological management. Drug utilisation studies help evaluate prescribing patterns, rational drug use, treatment adherence, and cost-related factors in glaucoma management.

Aim: To evaluate the utilisation pattern of antiglaucoma medications and prescribing trends in a tertiary care hospital, Udaipur, Rajasthan, India.

Materials and Methods: The present cross-sectional study was conducted in the Ophthalmology Outpatient Department (OPD) at American International Institute of Medical Sciences, a Tertiary Care Institution, Udaipur, Rajasthan, India, from December 2024 to December 2025. A total of 127 patients diagnosed with glaucoma were included in the study. Data regarding demographic characteristics, clinical profile, prescribed medications, treatment patterns, dosing frequency, duration of therapy, and generic versus branded prescribing were collected using patient interviews and prescription records. Statistical analysis was performed using descriptive statistics and the Chi-square test. A p-value<0.05 was considered statistically significant.

Results: Topical therapy was prescribed in all patients. Monotherapy was the most common treatment pattern (38.6%), followed by polytherapy (31.5%) and Fixed Dose Combinations (FDCs) (29.9%). Prostaglandin analogues were the most frequently prescribed drug class. Generic medications accounted for 55.9% of prescriptions. No statistically significant association was observed between income level and type of drug prescribed (χ²=3.46, p=0.326).

Conclusion: The prescribing pattern of antiglaucoma medications in the present study demonstrated predominant use of prostaglandin analogues, monotherapy, FDCs, and generic medications within the study setting. Use of prostaglandin analogues, generic medications, and simplified treatment regimens may contribute to effective and cost-conscious glaucoma management.

Adrenergic beta-antagonists, Drug prescriptions, Generic drugs, Intraocular pressure, Prostaglandins

Glaucoma is a group of progressive optic neuropathies characterised by irreversible visual field loss and is one of the leading causes of blindness worldwide. It is estimated that more than 76 million people are affected by glaucoma globally, and the number is expected to exceed 110 million by 2040 due to population ageing and increased life expectancy (1). The burden of glaucoma is particularly high in low- and middle-income countries because of delayed diagnosis, limited access to ophthalmic care, and poor adherence to treatment (2). In addition to visual impairment, glaucoma also imposes a significant socioeconomic burden because of long-term treatment costs and loss of productivity (3).

Reduction of Intraocular Pressure (IOP) remains the mainstay of glaucoma management and can be achieved through pharmacological, laser, or surgical interventions. Among these, pharmacotherapy is the most commonly used first-line treatment in clinical practice (4). Since glaucoma requires long-term therapy, evaluation of prescribing patterns and drug utilisation practices is important for ensuring rational and effective treatment. According to the World Health Organisation (WHO), drug utilisation studies evaluate the prescribing, dispensing, and use of medications, with emphasis on their medical, social, and economic consequences (5). Such studies are useful in assessing prescribing trends and identifying irrational prescribing practices in healthcare settings.

Despite the availability of established treatment guidelines, variations in prescribing practices still exist among healthcare Institutions. Irrational prescribing practices such as inappropriate polytherapy, unnecessary drug combinations, and deviation from evidence-based guidelines may increase treatment burden and healthcare costs (6). In resource-limited settings, high out-of-pocket expenditure may further contribute to poor adherence and inadequate disease control (7). Cost-related non adherence is an important concern in glaucoma because poor compliance can lead to disease progression and visual loss.

Patient adherence is another major challenge in glaucoma management. Studies have reported that adherence to topical antiglaucoma medications is often suboptimal due to factors such as complex dosing schedules, side effects, treatment cost, and inadequate patient awareness (8). FDCs may simplify treatment regimens and reduce dosing burden; however, adherence was not directly assessed in the present study; however, their utilisation varies across different clinical settings (9).

Several studies conducted in different regions of India have evaluated antiglaucoma drug utilisation patterns and prescribing practices. Previous studies have reported variations in drug selection, utilisation of FDCs, generic prescribing, and treatment approaches across healthcare settings (10),(11),(12),(13). These findings indicate that prescribing trends may vary due to differences in patient demographics, disease characteristics, socioeconomic status, healthcare accessibility, drug availability, and institutional treatment protocols. Although several Indian studies have evaluated antiglaucoma drug utilisation patterns, published evidence from southern Rajasthan remains limited. Region-specific evaluation of prescribing patterns is important for assessing rational drug use, understanding the utilisation of FDCs and generic medications, and evaluating prescribing practices that may support long-term treatment adherence. Therefore, the present study aimed to analyse the utilisation pattern of antiglaucoma drugs in a tertiary care teaching hospital in Udaipur, Rajasthan, and the objective was to assess prescribing trends, use of monotherapy and polytherapy, utilisation of FDCs, and generic versus branded prescribing practices.

Material and Methods

The present cross-sectional study was conducted in the Ophthalmology OPD at American International Institute of Medical Sciences, a Tertiary Care Institution, Udaipur, Rajasthan, India, from December 2024 to December 2025. Ethical approval was obtained from the Institutional Ethics Committee (IEC Approval No.: PMU/PMCH/IEC/2024/228). Site permission for data collection was granted by the competent authority at American International Institute of Medical Sciences, Udaipur, to conduct the research and collect data from patients attending the Ophthalmology OPD. Written informed consent was collected from participants. Patient confidentiality and privacy were strictly maintained throughout the study. The tertiary care setting was selected because it provides access to patients with varying severity of glaucoma and different treatment patterns, making it suitable for drug utilisation research (14). The present cross-sectional observational study was conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The relevant STROBE reporting elements for cross-sectional studies have been addressed in the manuscript.

Inclusion criteria: Patients fulfilling the following criteria were included in the study:
i) Patients diagnosed with Primary Open Angle Glaucoma (POAG), angle-closure glaucoma, or secondary glaucoma;
ii) Patients aged more than 18 years;
iii) Availability of complete prescription records and clinical details, including IOP and treatment history.

Exclusion criteria: Patient records with incomplete data, missing prescription details, or unclear diagnosis of glaucoma were excluded from the study.

Sample size: A total of 127 patients diagnosed with glaucoma who fulfilled the inclusion criteria during the study period were included in the study using consecutive sampling. As the present study was an observational drug utilisation study conducted in a tertiary care hospital, all eligible patients attending the Ophthalmology OPD during the study duration were included to obtain representative prescribing and utilisation data.

Study Procedure

Eligible patients fulfilling the inclusion criteria were identified during OPD visits. The purpose of the study was explained to the patients, and written informed consent was obtained before data collection. Data were collected through patient interviews using a structured questionnaire and review of prescription records and medical case sheets.

The collected data included demographic details (age, gender, education, occupation, income), clinical variables (type of glaucoma, years of diagnosis, family history, comorbidities, IOP), and prescription variables (number of drugs prescribed, type of therapy, drug class, frequency, duration, and type of drug- generic or branded). All data were entered into a predesigned master chart for statistical analysis. The study was purely observational, and the investigators did not influence prescribing decisions.

STATISTICAL ANALYSIS

The data were analysed using Statistical Package for Social Sciences (IBM SPSS) statistics version 25.0. Descriptive statistics were used o describe demographic, clinical, and prescription features, and the findings were provided in frequencies, percentages, and distributions. Descriptive analysis brings a basic understanding of the patterns of drug utilisation and is a key element in pharmacoepidemiological studies.

A Chi-square (χ²) test was used to assess associations between categorical variables, including type of glaucoma and therapy type, and drug class and glaucoma type, where the assumptions of the test were satisfied. Chi-square is a commonly used test in healthcare studies to determine the relationships between categorical variables and whether there is a statistically significant difference in the patterns of distribution (15). The level of significance used was p<0.05, which was deemed to be statistically significant.

Results

Demographic profile: A total of 127 patients diagnosed with glaucoma were included in the study. The majority of patients belonged to the 55-59 years age group 41 (32.3%), followed by 60-64 years 39 (30.7%), 65-70 years 28 (22.0%), and 50-54 years 19 (15.0%), indicating a higher prevalence of glaucoma among older adults. No eligible patients in the 18-49 year age group were encountered during the study period (Table/Fig 1), (Table/Fig 2). Females constituted 70 (55.1%) of the study population, while males accounted for 57 (44.9%). Based on residence, 46 (36.2%) of patients belonged to urban areas, 41 (32.3%) to semi-urban areas, and 40 (31.5%) to rural areas. Income distribution showed that 37 (29.1%) of participants had a monthly income below 10,000.

Clinical Characteristics: POAG was the most common type of glaucoma observed in the study population, accounting for 80 (63.0%) of cases. Angle-closure glaucoma and secondary glaucoma were observed in 30 (23.6%) and 17 (13.4%) of patients, respectively. Regarding duration since diagnosis, 48 (37.8%) of patients had been diagnosed with glaucoma for 1-2 years, while 40 (31.5%) had a duration of 6-12 months. About 39 (30.7%) of patients had been diagnosed for more than two years. Family history of glaucoma was present in 59 (46.5%) of patients, whereas 68 (53.5%) reported no family history. Co-morbid conditions were observed in 85/127 (66.9%) of patients. Diabetes mellitus alone was present in 45 (35.4%), hypertension alone in 40 (31.5%), while 42 (33.1%) had no recorded co-morbidity (Table/Fig 3). The IOP recorded at the time of prescription was highest at 29 mmHg in 30 (23.6%), followed by 27 mmHg 21 (16.5%) and 25 mmHg 20 (15.7%).

Drug utilisation patterns: All patients included in the study received topical antiglaucoma therapy. No patients were prescribed oral or parenteral antiglaucoma medications. A total of 87 patients (68.5%) received a single antiglaucoma medication, whereas 40 patients (31.5%) received more than one medication, indicating that monotherapy was more commonly prescribed than multidrug regimens (Table/Fig 4).

Monotherapy was the most commonly prescribed treatment pattern, 49 (38.6%), followed by polytherapy, 40 (31.5%), and FDCs, 38 (29.9%). A total of 68.5% of patients received a single drug, whereas 31.5% received more than one drug (Table/Fig 5).

Prostaglandin analogues, particularly latanoprost, were the most commonly prescribed class of antiglaucoma medications 49 (38.6%). Combination therapies included prostaglandin analogue and beta-blocker combinations 38 (29.9%), while triple-drug therapy consisting of beta-blockers, alpha-2 agonists, and carbonic anhydrase inhibitors accounted for 40 (31.5%) of prescriptions.

Once-daily dosing was prescribed for 87 patients (68.5%), whereas 40 patients (31.5%) received twice-daily dosing schedules (Table/Fig 6).

No statistically significant association was observed between glaucoma type and therapy type (χ²=7.90, p=0.095). Monotherapy was more commonly prescribed among patients with POAG, whereas polytherapy was relatively more frequent among patients with secondary glaucoma (Table/Fig 7).

No statistically significant association was observed between drug class and glaucoma type (χ²=8.28, p=0.219). Prostaglandin analogues were more frequently prescribed among patients with POAG, whereas triple-drug combinations were relatively more common among patients with secondary glaucoma.

Once-daily dosing was observed in all patients receiving monotherapy 49/49 (100%) and FDCs 38/38 (100%), whereas all patients receiving polytherapy 40/40 (100%) were prescribed twice-daily dosing (Table/Fig 8).

Generic vs branded drug analysis: Generic medications were prescribed more frequently than branded medications, accounting for 55.9% and 44.1% of prescriptions, respectively.

Chi-square analysis showed no statistically significant association between income level and type of drug prescribed (χ²=3.46, p=0.326). However, generic drug utilisation was comparatively higher among lower-income groups, whereas branded drug use was slightly higher among higher-income groups (Table/Fig 9).

Prescribing behaviour insights: The prescribing pattern observed in the study showed a preference for simplified treatment regimens. Once-daily dosing was the most common regimen (68.5%), which may be attributed to the frequent use of prostaglandin analogues. Polytherapy was more commonly associated with twice-daily dosing schedules (31.5%), indicating comparatively complex treatment regimens in certain patients. The duration of therapy reflected the chronic nature of glaucoma management.

Most patients, 126 (99.2%), had been receiving treatment for more than six months, highlighting the need for long-term pharmacological management and sustained treatment adherence (Table/Fig 10).

Overall, the prescribing trends observed in the study included: gradual escalation from monotherapy to combination therapy and polytherapy, frequent use of evidence-based drug classes, adherence-oriented approaches such as FDCs and once-daily dosing, and generic medications for cost-effective treatment. These findings indicate a structured prescribing pattern in glaucoma management within the study setting.

Discussion

The present study evaluated the utilisation pattern of antiglaucoma medications and prescribing trends in a tertiary care hospital. The findings demonstrated a preference for evidence-based prescribing practices, with prostaglandin analogues being the most commonly prescribed drugs and monotherapy being the predominant treatment approach.

The high utilisation of prostaglandin analogues as observed in the present study is consistent with their established role in contemporary glaucoma management (16). These agents are preferred because of their effective IOP-lowering action, once-daily dosing schedule, and favourable safety profile (4). Prostaglandin analogues improve uveoscleral outflow and provide sustained reduction in IOP, making them suitable for long-term glaucoma management (17). The prescribing pattern observed in the present study therefore reflects adherence to evidence-based clinical practice.

Polytherapy was more commonly observed among patients with secondary glaucoma. This may be attributed to the comparatively complex nature of secondary glaucoma, which is often associated with underlying ocular or systemic conditions, inflammation, trauma, or steroid use affecting aqueous humour dynamics. In such cases, monotherapy may not provide adequate IOP control, necessitating the use of multiple medications acting through different mechanisms (1). From an economic perspective, the choice of therapy in glaucoma management is influenced by treatment cost, patient adherence, and medication accessibility. Monotherapy is generally associated with lower treatment cost and simpler dosing schedules, particularly during the early stages of disease management when adequate IOP control can be achieved with a single medication (18). FDCs may improve treatment adherence by reducing dosing frequency and simplifying treatment regimens. This is especially important in chronic diseases such as glaucoma, where long-term therapy is required (9). The use of FDCs observed in the present study may reflect attempts to improve patient convenience and medication adherence. Polytherapy was more commonly used in patients requiring intensive IOP control. However, multiple-drug therapy may increase treatment cost, dosing frequency, and the risk of adverse effects, which can negatively affect adherence. Therefore, early disease management and appropriate treatment selection remain important in reducing treatment complexity and improving long-term compliance.

The higher utilisation of generic medications observed in the present study reflects a preference for cost-effective prescribing practices. Generic drugs provide therapeutic efficacy comparable to branded medications at a lower cost, making them important for improving treatment accessibility, particularly in low- and middle-income settings (6). No statistically significant association was observed between patients’ income level and the type of drug prescribed. This finding suggests relative uniformity in prescribing practices across different socioeconomic groups within the study setting. Although generic prescribing may improve affordability and accessibility, factors such as patient confidence, perceived drug quality, and awareness regarding generic medications can influence their acceptance. Appropriate regulatory measures and physician awareness are therefore important for promoting rational generic drug use (19).

Poor adherence to glaucoma medications is an important challenge in long-term disease management and may lead to inadequate IOP control and disease progression (8). The association observed between dosing frequency and therapy type in the present study provides insight into factors that may influence medication adherence. Once-daily dosing regimens, commonly associated with prostaglandin analogue therapy, are generally linked with better patient adherence because of their simplicity and convenience (8). In contrast, twice-daily regimens and polytherapy increase treatment complexity and may negatively affect adherence. Polytherapy may increase the likelihood of missed doses because of multiple medications, varying administration schedules, and increased risk of adverse effects. Therefore, simplified treatment regimens should be preferred whenever clinically appropriate. FDCs may improve adherence by reducing the number of medications and dosing frequency while maintaining therapeutic efficacy. Incorporating adherence-related considerations into prescribing practices is important for effective long-term glaucoma management.

In the present study, prostaglandin analogues were the most commonly prescribed antiglaucoma medications (38.6%), followed by polytherapy (31.5%) and FDCs (29.9%). Similar findings were reported by Bhartiya S et al., in North India, where travoprost was the most frequently prescribed antiglaucoma medication, and by Tanito M in Japan, who reported prostaglandin F₂α (F2 alpha) receptor agonists as the predominant therapeutic class (13),(20). Valladales-Restrepo LF et al., also demonstrated extensive utilisation of prostaglandin analogues and FDCs in a large population-based study conducted in Colombia (21). In contrast, earlier Indian studies conducted by Advani M and Jadhao T and by Niraj N et al., reported timolol as the most frequently prescribed antiglaucoma medication (11),(12). The difference observed between these studies and the present study may reflect evolving prescribing practices and increasing adherence to contemporary glaucoma management guidelines that recommend prostaglandin analogues as first-line therapy because of their superior IOP-lowering efficacy, favourable safety profile, and convenient once-daily dosing schedule.

Generic prescribing accounted for 55.9% of prescriptions in the present study. This proportion was higher than that reported by Niraj N et al., (19.43%) (12) and slightly higher than that observed by Advani M and Jadhao T (53%) (11). In contrast, Tanito M reported generic utilisation of only 14.8% in Japan (20). These differences may be attributable to variations in healthcare policies, drug availability, prescribing preferences, and economic factors across different healthcare systems. The utilisation of FDCs observed in the present study (29.9%) was comparable to findings reported by Tanito M and Valladales-Restrepo LF et al., who also demonstrated substantial use of combination therapies in glaucoma management (20),(21). FDCs reduce dosing burden, simplify treatment regimens, and may improve treatment convenience while maintaining therapeutic efficacy. Similar studies from the literature have been tabulated in (Table/Fig 11) (10),(11),(12),(13),(20),(21).

Overall, the findings of the present study support the growing trend towards evidence-based prescribing, increased utilisation of prostaglandin analogues, rational use of FDCs, and greater emphasis on cost-effective prescribing practices in glaucoma management.

The similarities observed between the present findings and those reported from different regions of India and other countries suggest increasing alignment of glaucoma prescribing practices with current therapeutic recommendations.

Limitation(s)

The present study has certain limitations that should be considered while interpreting the findings. The sample size of 127 patients may limit the generalisability of the results. Studies with larger sample sizes may provide more comprehensive evaluation of prescribing trends and subgroup differences. The study was conducted in a single tertiary care hospital, which may limit the applicability of the findings to other healthcare settings, particularly primary care centres and rural healthcare facilities. Prescribing practices may vary across Institutions depending on patient population and availability of medications. The cross-sectional study design limits the assessment of long-term outcomes such as disease progression, treatment adherence over time, and changes in prescribing patterns. In addition, the study was based on prescription records and patient-reported information, which may not accurately reflect actual medication adherence. Further multicentric and longitudinal studies are required to better evaluate prescribing trends, adherence patterns, and long-term treatment outcomes in glaucoma management.

Conclusion

The present study demonstrated that the prescribing pattern of antiglaucoma medications in the study setting was generally rational and consistent with current clinical practices. Prostaglandin analogues were the most commonly prescribed first-line agents, while FDCs and polytherapy were used according to treatment requirements and disease severity. These findings reflect adherence to evidence-based approaches in glaucoma management. The increased utilisation of generic medications observed in the study highlights the importance of cost-effective prescribing, particularly in long-term management of glaucoma. In addition, the use of simplified treatment regimens such as once-daily dosing and FDCs may contribute to improved patient adherence. The study emphasises the importance of rational prescribing practices, appropriate treatment selection, and adherence-oriented therapy in achieving effective glaucoma management. Further multicentric and longitudinal studies are recommended to better evaluate long-term treatment outcomes, prescribing trends, and patient adherence patterns.

DOI and Others

DOI: 10.7860/JCDR/2026/90347.24362

Date of Submission: May 25, 2026
Date of Peer Review: Jun 16, 2026
Date of Acceptance: Aug 05, 2026
Date of Publishing: Sep 01, 2026

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 05, 2026
• Manual Googling: Aug 01, 2026
• iThenticate Software: Aug 03, 2026 (6%)

ETYMOLOGY: Author Origin

EMENDATIONS: 8